FitzGerald J M, Gibson P G
Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Research Institute, Vancouver General Hospital, Vancouver, BC, V5Z 1L8, Canada.
Thorax. 2006 Nov;61(11):992-9. doi: 10.1136/thx.2005.045195.
Asthma exacerbations are common. They account for a significant morbidity and contribute a disproportionate amount to the cost of asthma management. The optimal strategies for the prevention of asthma exacerbations include the early introduction of anti-inflammatory treatment-most commonly, low dose inhaled corticosteroids. This should be coupled with a structured education programme which has a written action plan as an integral component. Where patients continue to be poorly controlled, the addition of a long acting beta agonist should be considered. The latter should not be used as monotherapy and should always be used with inhaled corticosteroids. Atopic patients with a history of repeated exacerbations, especially if they are steroid dependent and with a raised IgE, may be considered as potential candidates for omalizumab. In the early stages of an asthma exacerbation, doubling the dose of inhaled corticosteroids has been shown to be ineffective. The ideal strategy for the management of worsening asthma in patients on combination treatment, especially salmeterol and fluticasone, is uncertain. There is an emerging body of evidence for strategies on how to prevent progression to an exacerbation in patients taking a combination of budesonide and formoterol.
哮喘急性加重很常见。它们导致了显著的发病率，并在哮喘管理成本中占比过高。预防哮喘急性加重的最佳策略包括尽早开始抗炎治疗——最常见的是低剂量吸入性糖皮质激素。这应辅以一个结构化教育项目，该项目将书面行动计划作为一个组成部分。如果患者的病情仍控制不佳，则应考虑加用长效β受体激动剂。后者不应作为单一疗法使用，而应始终与吸入性糖皮质激素联合使用。有反复急性加重病史的特应性患者，尤其是那些依赖类固醇且IgE升高的患者，可被视为奥马珠单抗的潜在候选者。在哮喘急性加重的早期，吸入性糖皮质激素剂量加倍已被证明无效。对于接受联合治疗（尤其是沙美特罗和氟替卡松）的患者，管理哮喘病情恶化的理想策略尚不确定。对于服用布地奈德和福莫特罗联合制剂的患者，如何预防病情进展为急性加重的策略，相关证据正在不断涌现。
